194 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



bacilli being found in the interior of the tube, Avhile in the chronic 

 form the wall of the tube undergoes thickening and infiltration 

 with new cells, while its contents contain only a few bacilli. 

 The increase in size of the tube is due to the collection of pus in its 

 interior, as well as to the hypertrophy of the wall. When suppu- 

 ration takes place in the interior of the tube the tubercular product 

 has become the seat of a secondary infection with pus-microbes, 

 hence the indications for operative treatment have become more 

 urgent. 



An interesting case of primary tuberculosis of the uterus and 

 Fallopian tubes is reported by Lebedeff. The patient was the 

 widow of a man who had died of pulmonary tuberculosis. An 

 examination before the operation revealed a firm, nodulated, intra- 

 abdominal tumor in the space of Douglas. An attempt was made 

 to remove the tumor by laparotomy, but had to be abandoned as 

 the disease had become too widely disseminated. Six weeks later 

 the patient died with symptoms of general tuberculosis. At the 

 post-mortem miliary tuberculosis was found in the peritoneum, 

 lungs, colon, uterus, and Fallopian tubes. The most advanced 

 stages of the disease were found in the uterus and Fallopian tubes, 

 showing that the disease had commenced in these organs. Both 

 the Fallopian tubes were dilated and filled with pus, the epithelium 

 in parts being absent. Stained sections from the uterus and tubes 

 showed the presence of numerous bacilli. 



Jouin (Bulletin Paris Obstet. and G-yn. Soc., March, 1889) 

 believes that tuberculous endometritis from local infection is quite 

 a common affection. Of nine cases which were observed by him, 

 it was due to sexual contact with men suffering from genital tuber- 

 culosis. In two others the husbands were tuberculous, but had no 

 genital tuberculosis. He calls attention to the fact that Cornil and 

 Chantemesse have produced it in rabbits by injecting bacilli into 

 the vagina. 



Mamma. A number of well -authenticated cases of primary 

 tuberculosis of the mamma have recently been reported. So far 

 as the infection is concerned, the breast must be considered as an 

 appendage of the skin. The bacillus of tuberculosis, from without, 

 may effect entrance into the gland through the milk-ducts, in 

 which case the inflammatory process commences in the parenchyma 

 of the gland, or it may enter through a fissure of the nipple, in 

 which case the process is primarily interstitial. Where direct 

 infection from without can be excluded, the disease is the result of 

 auto-infection, and, on this account, the prognosis is always more 

 unfavorable. The regional dissemination takes place along the 

 chain of the axillary lymphatic glands. Orthmann ("Ueber 

 Tuberculose der weiblichen Brustdriise," etc., Virchow's Archiv, 



